new practice of gynecology

tassjohn32

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Hello,
We just opened and I'm in charge of billing and some coding in the office, the Dr. has done several outpatient procedures that need billing:

D&C hysteroscopy; polypectomy: she is wanting me to use 58120,58555,57500 is she correct and will there be a modifier used?
THL BSO: 58572 (b/c of the weight)

Also, she has been using ex. 99385 for an annual exam also 99203 when she finds a problem. When I bill I use modifier 25 on the e/m code 99203. Is this correct because some plans will pay and some say those codes mean the same thing and will not pay for those procedures on the same day?
 

CodingKing

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You don't get to automatically bill a sick visit with the annual exam just because something is found. Also if procedurfe is done the same day that E&M is bundled into it.

58572 would not be billed for a polypectomy. Hysterectomy codes are chosed based on weight of Uterus
Diagnostic Scope is bundled into surgical scopes as well

Sounds like 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C
 

tassjohn32

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Stanford, KY
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You don't get to automatically bill a sick visit with the annual exam just because something is found. Also if procedurfe is done the same day that E&M is bundled into it.

58572 would not be billed for a polypectomy. Hysterectomy codes are chosed based on weight of Uterus
Diagnostic Scope is bundled into surgical scopes as well

Sounds like 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C




Ok, what if the insurance paid for both procedures? Will they ask for recoupment?
 

CodingKing

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Ok, what if the insurance paid for both procedures? Will they ask for recoupment?


If hysterectomy was billed when it wasn't a hysterectomy, If any service is misreported you really have a duty to contact the payer and refund and not wait for them to discover it later. If government payer the quicker the better.
 
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